Alcoholic beverage preference, 29-year mortality, and quality of life in men in old age

Authors of a recent study compared 29-year mortality and quality of life in old age by alcoholic beverage preference (beer, wine, or spirits) in a cohort of men whose socio economic status was similar in their adult life. In 1974, cardiovascular risk factors and beverage preference were assessed in 2,468 businessmen and executives aged 4055 years. Of them, 131 did not drink alcohol, 455 did not report a single preference, and 694, 251, and 937 preferred beer, wine, and spirits, respectively. Quality of life with a RAND-36 Short Form (SF)-36 instrument was surveyed in 2000 in survivors. Mortality was retrieved from registers during the 29-year follow up.

Results showed that alcoholic beverage preference tracked well during the follow up. Total alcohol consumption was not significantly different between preference groups. Men with wine preference had the lowest total mortality due to lower cardiovascular mortality. With the spirits group as the reference category and age, cardiovascular risk factors, and total alcohol consumption as covariates, wine drinkers had a 34% lower total mortality (relative risk 0.66; 95% CI, 0.450.98); relative risk for beer preferers was 0.91 (95% CI, 0.681.14). In 2000, wine preferers had the highest scores in all RAND-36 scales; general health (p = 0.007) and mental health (p = 0.01) were also significantly different.

The authors conclude that in this male cohort from the highest social class, wine preference was associated with lower mortality and better quality of life in old age. Mortality advantage was independent of overall alcohol consumption and cardiovascular risk factors, but contributing personal characteristics or early life differences cannot be excluded.

R. Curtis Ellison comments: While animal experiments show that many components of wine (especially polyphenols) have important protective effects against the development of atherosclerosis, thrombosis, and other disorders (in addition to those seen from alcohol), data from human studies are inconsistent. Most of the large US studies show little difference between “wine drinkers” and “beer or spirits drinkers”.

The key problem has always been that in humans, we are studying not wine versus other beverages but health differences among people who state that they generally prefer or consume one beverage. Further, most people consume more than one type of alcoholic beverage. Of even more importance is that lifestyles tend to be quite different (at least in the US) between wine drinkers, beer drinkers, and spirits drinkers. There is always the problem when studying humans that wine drinkers may appear to have healthier outcomes not from the wine that they drink but from other lifestyle habits, such as a healthier diet, less smoking, more exercise, etc.

The present study was limited to businessmen and executives who were apparently very similar in other lifestyle factors except that some preferred wine while others preferred beer or spirits. Thus, the potential confounding effects of education and income are likely to be similar in the different beverage groups. Further, at baseline, beer and wine drinkers had very similar body weight, blood pressure, smoking habits, and most risk factors for cardiovascular disease. And when the authors adjusted for total alcohol intake and a number of cardiovascular risk factors, the preferable outcomes in terms of mortality and quality of life persisted for wine drinkers.

These data support the findings from experimental studies that the polyphenols that are present especially in wine may provide additional protection, over that from alcohol, against cardiovascular disease. Still, this is an observational study, and residual confounding by unmeasured lifestyle factors may still be a factor in the better outcomes seen among wine drinkers.